Journal of Nutrition EB Program 2010 Abstracts

Home Help [Feedback] [For Subscribers] [Archive] [Search] [Contents]
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Weiler, H. A.
Right arrow Articles by Metge, C. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Weiler, H. A.
Right arrow Articles by Metge, C. J.
© 2007 The American Society for Nutrition J. Nutr. 137:461-465, February 2007

Community and International Nutrition

Canadian Aboriginal Women Have a Higher Prevalence of Vitamin D Deficiency than Non-Aboriginal Women Despite Similar Dietary Vitamin D Intakes1,2

Hope A. Weiler3,*, William D. Leslie4, John Krahn4, Pauline Wood Steiman6 and Colleen J. Metge5

3 Human Nutritional Sciences, 4 Faculty of Medicine, and 5 Faculty of Pharmacy, University of Manitoba, Winnipeg, R3T 2N2 MB, Canada and 6 Assembly of Manitoba Chiefs, Winnipeg, R3C 0M6 MB, Canada

* To whom correspondence should be addressed. E-mail: hope.weiler{at}mcgill.ca.


   ABSTRACT
TOP
 ABSTRACT
Introduction
 Materials and Methods
 Results
 Discussion
 LITERATURE CITED
 
Canadian Aboriginal women have high rates of bone fractures, which is possibly due to low dietary intake of minerals or vitamin D. This study was undertaken to estimate dietary intake of calcium and vitamin D by designing a culturally appropriate dietary survey instrument and to determine whether disparities exist between Aboriginal and white women. After validation of a FFQ, 183 urban-dwelling and 26 rural-dwelling Aboriginal women and 146 urban white women completed the validated FFQ and had serum 25-hydroxyvitamin D [25(OH)D] measured. Urban Aboriginal women had lower (P = 0.0004) intakes of total dietary calcium than urban white women; there was no difference in rural Aboriginal women. Only a minority of all women met the adequate intake (AI) for calcium intake. Ethnicity did not affect total vitamin D intake; however, rural Aboriginal women consumed all of their dietary vitamin D from food sources, which was more (P < 0.03) than both urban Aboriginal and white women. Rural and urban Aboriginal women had lower (P < 0.0004) serum 25(OH)D than urban white women. We found that 32% of rural Aboriginal, 30.4% of urban Aboriginal, and 18.6% of urban white women were vitamin D deficient, with serum 25(OH)D concentrations <37.5 nmol/L. The high prevalence of vitamin D deficiency among Aboriginal women, combined with lower dietary intake of calcium, especially in older women, likely contributes to the higher incidence of fracture in this population.


   Introduction
TOP
 ABSTRACT
 Introduction
Materials and Methods
 Results
 Discussion
 LITERATURE CITED
 
The influence of dietary calcium and vitamin D status on bone health has long been accepted (1). The rate of all fractures in Aboriginal women is 2-fold that of non-Aboriginal women (2). Whether this high fracture rate is associated with dietary intake of minerals or vitamin D is not clear. In Canada, the risk for low dietary intake of calcium (3–5) and deficient vitamin D status (6–10), as indicated by circulating 25-hydroxyvitamin D [25(OH)D]7 concentrations <37.5 nmol/L, is exceptionally high in adult Aboriginal women (9,10).

The 24-h recall method is the most frequently used approach in quantitatively assessing dietary intake in Aboriginal populations, including Canadian Aboriginals (11–13). The 24-h recall is dependent on season and must be performed each season to reflect intake as regulated by food availability. This is an important consideration, because a number of traditional foods are high in calcium, but they are not consumed throughout the year. This also is true for vitamin D from consumption of milk products, fish, and fish liver oils. FFQ are designed to capture intake over an extended period of time that would reflect seasonal variations in food intake. A FFQ including traditional foods has been successfully used in Canadian Inuit populations (14) and American Native children (15). A FFQ reflecting the dietary practices of Aboriginal women in Manitoba was not available. Therefore, the objective of the First Nations Bone Health Study (FNBHS) was to accurately estimate dietary intake of calcium and vitamin D, by designing a culturally appropriate dietary survey instrument, and then determine whether disparities exist in dietary calcium, dietary vitamin D intake, and serological indicators of vitamin D sufficiency in a large cohort of Aboriginal and white women.


   Materials and Methods
TOP
 ABSTRACT
 Introduction
 Materials and Methods
Results
 Discussion
 LITERATURE CITED
 
We hired an Aboriginal research nurse as the project coordinator and Aboriginal community workers to screen potential respondents, function as trained interviewers, and administer the survey questionnaire. The study recruitment was conducted from June 2002 through March 2004. The FNBHS, including development, piloting, and validation of the modified FFQ, was approved by the University of Manitoba Research Ethics Board. Signed informed consent was obtained from all subjects.

    Development and pretesting of the questionnaire. The FFQ used in the Canadian Multicentre Osteoporosis Study (16), which is specific to calcium and vitamin D, was adapted to include traditional foods known to be either high or low in calcium, but already reported to be consumed in large enough quantities to contribute to dietary calcium intake (e.g., bannock bread at 84 mg/serving). The adapted FFQ was then tested for its content validity with respect to the nutritional habits of Aboriginal women ≥20 y, through one-on-one interviews with urban Aboriginal women (n = 8) and focus groups (15 women in 3 groups) and subsequently tested for reliability in another 8 Aboriginal women.

We decided that the survey would be used; however, it would be administered by an interviewer, because food models helped, measurements would be in standard household units (e.g., cups), and language barriers could be accommodated.

    Validation of the FFQ. We used the 24-h recall method for assessing dietary intake and blood sampling to determine 25(OH)D concentrations. Participants completed the FFQ with the assistance of a registered dietitian, who subsequently conducted the 24-h recall interview. The assessments were repeated twice more at 2-wk intervals. The 24-h recall and FFQ intake data were entered into the NutriWatch nutrient analysis software program and totals for calcium and vitamin D were calculated and averaged. Dietary intakes of calcium and vitamin D were compared between the 24-h recall and FFQ on 3 different occasions for each participant. Further validation was done by comparing test results to serum 25(OH)D measured at the final visit at the end of October. The reliability of the FFQ and 24-h recall methods was examined by calculating the CV for calcium and vitamin D intakes.

    Subjects. The study population consisted of urban Aboriginal, rural Aboriginal, and urban non-Aboriginal females (white). For the urban cohort, we used the Status Verification System files and the provincial (Manitoba Health) registry files to identify women residing at a Winnipeg address, to which a letter introducing the study had been mailed. For this study, urban was defined as when the subject lived within 50 km of the Winnipeg study center. Subjects who were pregnant or recently pregnant and those currently or recently breastfeeding (within 6 mo) were excluded. Rural recruitment focused on 2 Aboriginal communities, one from the northern Manitoba zone and the other from the south. Local community interviewers were identified from each of these communities and they completed interviewer-training sessions. Random samples were drawn from the band lists.

    Clinical assessment. Vitamin D status was assessed from serum 25(OH)D concentrations measured using RIA (Diasorin) at the Winnipeg Health Sciences Centre, where the inter-assay CV was 6–13%. The assay measures both ergocalciferol (D2) and cholecalciferol (D3).

Body weight was measured to the nearest 0.5 lb with a portable digital scale (Tanita TBF-612) and subsequently converted to kg. Height was measured to the nearest 0.1 cm with a Harpenden pocket stadiometer (Holtain).

    Statistical analysis. Normality of the data were tested using the method of Kolmogorov and Smirnov. Data that were not normally distributed [all data from FFQ and 25(OH)D] were log transformed prior to analysis. Factorial ANOVA was used to identify the main effects of ethnicity (Urban white, Urban Aboriginal, and Rural Aboriginal) and age groups were defined using the dietary recommended intake (DRI) ranges. The age ranges for the groups were divided into women 25–50 y and ≥51 y. The DRI values for women 25–50 y are 1000 mg calcium and 5 µg vitamin D. For women ≥51 y, the DRI for calcium is 1200 mg. The requirement for vitamin D is 10 µg for 51- to 70-y-old women and 15 µg for those >70 y; however, because there were few women over 70 y, the groups were combined. Post-hoc testing with least square means and Bonferroni correction was used when a main effect of ethnic group was identified, or if an ethnic group by age-group interaction was identified. Simple linear regression was used to examine the relation between vitamin D intake and serum 25(OH)D concentrations. Differences with P < 0.05 were considered significant.


   Results
TOP
 ABSTRACT
 Introduction
 Materials and Methods
 Results
Discussion
 LITERATURE CITED
 
Eight Aboriginal women participated in the validation of the FFQ, but 2 withdrew after the first visit, and only 5 agreed to blood sampling. When results obtained from the FFQ and the 3-d mean of the 24-h recalls were compared, we found that the CV for calcium by FFQ was 41.5% and by 24-h recall it was 58.3%. For vitamin D, the CV by FFQ was 38.2% and by 24-h recall it was 85.8%. The difference between the methods was at or within the limits of agreement for 5 of 6 women, regarding calcium and vitamin D intakes. Both the 24-h recall and FFQ yielded a vitamin D intake that was positively related to vitamin D status (Fig. 1).


Figure 1
View larger version (9K):
[in this window]
[in a new window]

  		Figure 1  Relations between mean dietary vitamin D intake and serum 25(OH)D concentration, from 3 24-h recalls and 3 FFQ, in 5 Aboriginal women in the months of October or November. Identical symbols indicate the same subject.

 
Of the urban women initially contacted by mail, 456 responded to the study invitation. However, 18 did not attend the research visit or did not complete the study, and 82 were excluded due to an invalid FFQ. Therefore, this report reflects data from 356 complete FFQ. Twenty-six rural Aboriginal women participated (25 during the months of April through October). Urban Aboriginal women (n = 184) were studied throughout the year, with the majority (72%) studied in November through March (n = 133). Urban white women (n = 146) were studied throughout the year, with 81 (55%) studied in November through March and 65 (45%) in April through October.

The women in this study were between 25 and 76 y of age. By design, there were no differences in age among the ethnic cohorts (Table 1). There was a main effect of age (P < 0.05) on body weight, with younger women weighing more than the older women (79.2 ± 19.2 vs. 77.2 ± 15.6 kg). There was also a main effect of both ethnicity (P < 0.03) and age (P < 0.0001) on height. Rural Aboriginal women were taller than urban Aboriginal women and white women were intermediate. Younger women were taller than older women.


View this table:
[in this window]
[in a new window]

  		TABLE 1 Anthropometry of rural and urban Aboriginal and urban white women1

 
Results of the 2-factor ANOVA showed no significant ethnic cohort-by-age interaction (Table 2). However, a significant (P = 0.006) main effect of ethnicity was noted with respect to total intake of calcium from food plus supplements; whereby, urban white women had higher (P = 0.0004) intakes than urban Aboriginal women. There was also a main effect (P < 0.006) of age, with older women consuming more calcium than younger women. Intake of calcium from food sources was greater (P < 0.02) in rural Aboriginal women than urban Aboriginals, but not different from urban white women. Supplemental calcium intakes varied as a function of ethnic group only, whereby rural and urban Aboriginal women had lower (P < 0.0001) intakes than white women, with no age effect noted. Rural Aboriginal women reported consuming no calcium supplements. The main food sources of calcium for all ethnic groups was from milk, followed by cheese, and, variably, by yogurt, orange juice, and breads.


View this table:
[in this window]
[in a new window]

  		TABLE 2 Dietary intake of calcium and vitamin D and vitamin D status of rural and urban Aboriginal and urban white women1

 
There was a main effect (P < 0.004) of age that revealed older women had higher intakes than younger women. There was a main effect of ethnicity (P = 0.0007) and age (P = 0.01) for intake of vitamin D from food sources. Rural Aboriginal women had higher (P < 0.03) intakes of vitamin D from food sources than urban aboriginal and urban white groups, and older women obtained more vitamin D from foods than young women. The main food sources of vitamin D for all ethnic groups were milk and margarine. A main effect (P < 0.0001) of ethnic group was identified for supplemental sources of vitamin D. Urban white women consumed higher (P < 0.0002) amounts than both urban and rural Aboriginal women. A total of 17 participants consumed fish liver oil supplements: 9 in the white urban cohort and 8 in the urban Aboriginal cohort. None of the rural Aboriginal women consumed any type of supplement.

There was a main effect (P < 0.001) of ethnic cohort on vitamin D status as assessed by serum 25(OH)D. Women in the rural and urban Aboriginal group had lower (P < 0.0004) concentrations than urban white women. There was also a main effect (P < 0.03) of age group. Older women had higher serum 25(OH)D concentrations than younger women. Dietary vitamin D intake and 25(OH)D were significantly related only in the white women (Fig. 2).


Figure 2
View larger version (14K):
[in this window]
[in a new window]

  		Figure 2  Relations between vitamin D status, as indicated by serum 25(OH)D concentration, and dietary vitamin D intake, as measured using a single FFQ, in rural Aboriginal women (A, n = 25), urban Aboriginal women (B, n = 182), or urban white women (C, n = 145).

 

   Discussion
TOP
 ABSTRACT
 Introduction
 Materials and Methods
 Results
 Discussion
LITERATURE CITED
 
To our knowledge, this study is the first to report dietary calcium and vitamin D intakes for a large Aboriginal urban cohort of women. In this cross-sectional study, we found that Canadian Aboriginal women, regardless of urban or rural residence, differed from white women in calcium and vitamin D intakes and vitamin D status. Although minor differences may be due to the season of sampling, this study suggests that nutrient intake may contribute to poor bone health among Aboriginal women in Canada.

The values for dietary calcium intake reported herein support other Canadian reports. Aboriginal women from Northern Manitoba Cree Communities have very low intakes of calcium (288–476 g/d) (13). Similarly, 58% of Ojibwa-Cree in Northern Ontario women have low calcium intakes; mean intakes range from 547 mg/d in women 20–49 y of age to 634 g/d in those >49 y (12). As many as 25% (3), and up to 70% (5), of white Canadian women do not achieve dietary intakes in line with the 1990 recommended calcium intakes of 700–800 mg/d (17). Newly published data from the Canadian Community Health Survey of over 30,000 Canadians show that women consume, on average, 1.6 servings of milk per day, which provides ~480 mg calcium. This is similar to the calcium contribution from milk seen in our study, which was 465 mg, well below the DRI of 1000–1200 mg/d (18) for adult women between 19 and 65 y of age. Only a minority of women in this study had an intake of calcium above the AI value.

In contrast to dietary calcium intake, more women met the AI for vitamin D. However, dietary intake of vitamin D was related to vitamin D status only in the white women of this study. The lack of an association between diet and vitamin D status in the Aboriginal women was not likely due to sampling in different seasons, because the proportion of white women studied in winter, when vitamin D status is most reflective of diet, was 55.5%, vs. 73% of Aboriginal women.

According to the DRI Committee, a serum 25(OH)D concentration <37.5 nmol/L is indicative of vitamin D deficiency (18). Using this cutoff, 32% of rural Aboriginal women, 30.4% of urban Aboriginal women, and 18.6% of urban white women in this study are defined as vitamin D deficient. A circulating 25(OH)D of 75 nmol/L is more recently thought to represent optimal status (19). Given this definition, 96% of rural Aboriginal, 84% of urban Aboriginal, and 62% of white women are below optimal vitamin D status. To obtain a serum 25(OH)D concentration of 75 nmol/L, 20–25 µg vitamin D would be required daily (19).

Regardless of the values of serum 25(OH)D used to indicate vitamin D deficiency or optimal vitamin D status, it is clear that vitamin D deficiency is common in Aboriginal women, possibly due to the predominance of residence in more extreme northern latitudes, skin pigmentation, or lifestyle. In Northern Manitoba (49°N), 76% of women have serum 25(OH)D concentrations in the deficient range (9). Similarly, in other predominantly white northern populations, 34% of women (27–89 y) living in Calgary (51°N) have low vitamin D status in at least 1 season (6). Even in the Toronto region (43°N), the prevalence of vitamin D deficiency is reported to be 14.8% in white women and 25.6% in nonwhite nonblack women (7). Dietary or supplemental vitamin D intakes at levels similar to the AI value of 5 µg/d did not improve deficiency rates in this population (18). Cutaneous synthesis of vitamin D in these regions is thought to be limited to April through September (20), placing many Canadians at risk for vitamin D deficiency and potentially limited bone mass or metabolism.

A recent report on Native American women suggests they have higher bone mass than white women but that bone mass is more readily lost during postmenopausal years (21). Vitamin D status and BMI, both of which are also health concerns in Canadian Aboriginal women (9,22), accounted for 70% of the variance in bone mass in lumbar spine and femoral neck (21). More rapid loss of bone and continued high bone turnover in aging might represent greater risk for fracture than suggested by bone mineral density, T-, and Z-scores (23). High bone turnover may be associated with inadequate dietary calcium and deficiency of vitamin D. Although BMI was not related to vitamin D status in this study, all cohorts and age groups were, on average, either overweight (25.0–29.9 kg/m2) or obese class I (30.0–34.9 kg/m2). Whether Aboriginal women in Manitoba have a higher fracture rate (2) as a result of inadequate dietary calcium, vitamin D, and vitamin D status as related to BMI requires further investigation.

The study is not without its limitations. The FFQ validation portion of the study suggests that the FFQ could be used to estimate intake of calcium and vitamin D in this population. It was not possible to accurately validate the FFQ because the number of participants in this questionnaire validation portion of the study was low. To further validate the FFQ results, blood sampling was done at the final study visit at the end of October, when 25(OH)D concentrations would be more reflective of diet than UVB exposure in Manitoba. Considering that the half-life of 25(OH)D is between 10 d and 3 wk (24), October may not have been late enough to eliminate the effect of endogenous synthesis; however, both the 24-h recall and FFQ yielded a vitamin D intake that was positively related to vitamin D status. Lastly, it would have been optimal to collect multiple 24-h recalls throughout the year, as the comparison method, but this was not feasible.

In summary, dietary calcium intake was below recommendations for both Aboriginal and white women. Despite intakes of vitamin D consistent with the adequate intake, vitamin D deficiency was evident in all women, regardless of age or ethnic grouping. Milk and margarine were key sources of vitamin D in this study and this underscores the importance of Canada's fortification policy, which mandates these 2 staple foods be fortified with vitamin D. Further exploration of how to remedy vitamin D deficiency in Aboriginal and white women will help to provide data from which to revise vitamin D fortification policy.


   ACKNOWLEDGMENTS
 
The authors thank the rest of the First Nations Bone Health Study Research Group: Dr. C. R. Greenberg, Dr. L. Lix, Dr. J. D. O'Neil, Dr. A. Tenenhouse, Dr. M. Doupe, Dr. L. Roos, Dr. E. A. Salamon, and Ms. A. Walker Young. Thanks to Ms. Laela Janzen for her assistance in modifying the food frequency questionnaire.


   FOOTNOTES
 
1 This research was funded by the Canadian Institutes of Health Research and the Manitoba Health Research Council. Back

2 In Canada, the terms Aboriginal or Native are used to refer to "Indians", and includes First Nations, Metis, and Inuit peoples. First Nations are Aboriginal peoples signatory to Treaties and/or recognized by the federal government as a fiduciary responsibility. This article reports on data derived exclusively from First Nations populations, which represent the large majority of Aboriginal persons living in Canada. Back

7 Abbreviations used: AI, adequate intake; DRI, dietary recommended intake; FNBHS, First Nations Bone Health Study; [25(OH)D], 25-hydroxyvitamin D. Back

Manuscript received 14 June 2006. Initial review completed 9 August 2006. Revision accepted 17 November 2006.


   LITERATURE CITED
TOP
 ABSTRACT
 Introduction
 Materials and Methods
 Results
 Discussion
 LITERATURE CITED
 

1. Brown JP, Josse RG. clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002;167:S1–34.

2. Leslie WD, Derksen S, Metge C, Lix LM, Salamon EA, Wood Steiman P, Roos LL. Fracture risk among First Nations people: a retrospective matched cohort study. CMAJ. 2004;171:869–73.[Abstract/Free Full Text]

3. Gray-Donald K, Jacobs-Starkey L, Johnson-Down L. Food habits of Canadians: reduction in fat intake over a generation. Can J Public Health. 2000;91:381–5.[Medline]

4. Mailhot M, Ghadirian P, Parent ME, Goulet MC, Petitclerc C. Patterns of calcium intake among French-Canadians living in Montreal. Can J Public Health. 1994;85:351–6.[Medline]

5. Ghadirian P, Shatenstein B. Nutrient patterns, nutritional adequacy, and comparisons with nutrition recommendations among French-Canadian adults in Montreal. J Am Coll Nutr. 1996;15:255–63.[Abstract]

6. Rucker D, Allan JA, Fick GH, Hanley DA. Vitamin D insufficiency in a population of healthy western Canadians. CMAJ. 2002;166:1517–24.[Abstract/Free Full Text]

7. Vieth R, Cole DE, Hawker GA, Trang HM, Rubin LA. Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D intake does not prevent it. Eur J Clin Nutr. 2001;55:1091–7.[Medline]

8. Weiler H, Fitzpatrick-Wong S, Veitch R, Kovacs H, Schellenberg J, McCloy U, Yuen CK. Vitamin D deficiency and whole-body and femur bone mass relative to weight in healthy newborns. CMAJ. 2005;172:757–61.[Abstract/Free Full Text]

9. Lebrun JB, Moffatt ME, Mundy RJ, Sangster RK, Postl BD, Dooley JP, Dilling LA, Godel JC, Haworth JC. Vitamin D deficiency in a Manitoba community. Can J Public Health. 1993;84:394–6.[Medline]

10. Waiters B, Godel JC, Basu TK. Perinatal vitamin D and calcium status of northern Canadian mothers and their newborn infants. J Am Coll Nutr. 1999;18:122–6.

11. deGonzague B, Receveur O, Wedll D, Kuhnlein HV. Dietary intake and body mass index of adults in 2 Ojibwe communities. J Am Diet Assoc. 1999;99:710–6.[Medline]

12. Wolever T, Hamad S, Gittelsohn J, Hanley A, Logan A, Harris S, Zinman B. Nutrient intake and food use in an Ojibwa-Cree community in Northern Ontario assessed by 24h dietary recall. Nutr Res. 1997;17:603–18.

13. Campbell M, Diamond R, Macpherson BD, Grunau M, Halladay JL. Energy and nutrient intakes of men (56–74 years) and women (16–74 years) in three Northern Manitoba Cree communities. J Can Diet Assoc. 1994;55:167–74.

14. Kuhnlein HV, Receveur O, Soueida R, Egeland GM. Arctic indigenous peoples experience the nutrition transition with changing dietary patterns and obesity. J Nutr. 2004;134:1447–53.[Abstract/Free Full Text]

15. Blum RE, Wei EK, Rockett HR, Langeliers JD, Leppert J, Gardner JD, Colditz GA. Validation of a food frequency questionnaire in Native American and Caucasian children 1 to 5 years of age. Matern Child Health J. 1999;3:167–72.[Medline]

16. Tenenhouse A, Joseph L, Kreiger N, Poliquin S, Murray TM, Blondeau L, Berger C, Hanley DA, Prior JC. Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int. 2000;11:897–904.[Medline]

17. Health and Welfare Canada. Nutrition Recommendations. The Report of the Scientific Review Committee. Government Document. Ottawa: Health and Welfare Canada; 1990.

18. Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.

19. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713–6.[Medline]

20. Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988;67:373–8.[Abstract/Free Full Text]

21. Perry, 3rd HM, Bernard M, Horowitz M, Miller DK, Fleming S, Baker MZ, Flaherty J, Purushothaman R, Hajjar R, et al. The effect of aging on bone mineral metabolism and bone mass in Native American women. J Am Geriatr Soc. 1998;46:1418–22.[Medline]

22. Katzmarzyk PT, Malina RM. Obesity and relative subcutaneous fat distribution among Canadians of First Nation and European ancestry. Int J Obes Relat Metab Disord. 1998;22:1127–31.[Medline]

23. Sornay-Rendu E, Munoz F, Duboeuf F, Delmas PD. Rate of forearm bone loss is associated with an increased risk of fracture independently of bone mass in postmenopausal women: the OFELY study. J Bone Miner Res. 2005;20:1929–35.[Medline]

24. Vicchio D, Yergey A, O'Brien K, Allen L, Ray R, Holick M. Quantification and kinetics of 25-hydroxyvitamin D3 by isotope dilution liquid chromatography/thermospray mass spectrometry. Biol Mass Spectrom. 1993;22:53–8.[Medline]




This article has been cited by other articles:


Home page
 J. Am. Coll. Nutr.Home page
S. N. Taylor, C. L. Wagner, and B. W. Hollis
Vitamin D Supplementation during Lactation to Support Infant and Mother
J. Am. Coll. Nutr., December 1, 2008; 27(6): 690 - 701.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
B. Hintzpeter, C. Scheidt-Nave, M. J. Muller, L. Schenk, and G. B. M. Mensink
Higher Prevalence of Vitamin D Deficiency Is Associated with Immigrant Background among Children and Adolescents in Germany
J. Nutr., August 1, 2008; 138(8): 1482 - 1490.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Weiler, H. A.
Right arrow Articles by Metge, C. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Weiler, H. A.
Right arrow Articles by Metge, C. J.

Home Help [Feedback] [For Subscribers] [Archive] [Search] [Contents]
Copyright © 2007 by American Society for Nutrition